August 26, 2016

UCLA neurosurgeons used ultrasound to “jump-start” the brain of a 25-year-old man from a coma, and he has made remarkable progress following the treatment.

The technique, called “low-intensity focused ultrasound pulsation” (LIFUP), works non-invasively and without affecting intervening tissues. It excites neurons in the thalamus, an egg-shaped structure that serves as the brain’s central hub for processing information.

“It’s almost as if we were jump-starting the neurons back into function,” said Martin Monti, the study’s lead author and a UCLA associate professor of psychology and neurosurgery. “Until now, the only way to achieve this was a risky surgical procedure known as deep brain stimulation, in which electrodes are implanted directly inside the thalamus,” he said. “Our approach directly targets the thalamus but is noninvasive.”

What about using it on vegetative or minimally conscious patients?

Monti cautioned that the procedure requires further study on additional patients before the scientists can determine whether it could be used consistently to help other people recovering from comas.

“It is possible that we were just very lucky and happened to have stimulated the patient just as he was spontaneously recovering,” Monti said.

If the technology helps other people recovering from coma, Monti said, it could eventually be used to build a portable device — perhaps incorporated into a helmet — as a low-cost way to help “wake up” patients, perhaps even those who are in a vegetative or minimally conscious state (MCS). Currently, there is almost no effective treatment for such patients, he said.

Israel Stinson (credit: Life Legal Defense Foundation)

On Thursday August 25, two year-old Israel Stinson, whose fight for life gained international attention, died Thursday after doctors at Children’s Hospital of Los Angeles removed him from a breathing ventilator against his parents’ wishes, after a Los Angeles Superior Court judge removed a restraining order, the Los Angeles Timesreports.

It’s not clear, going forward, why doctors or the FDA could ethically refuse to provide “compassionate access” to a treatment such as LIFUP as a last resort before pulling the plug.

Bystritsky is also a founder of Brainsonix, a Sherman Oaks, California-based company that provided the device (BXPulsar 1001) the researchers used in the study.

That device, about the size of a coffee cup saucer, creates a small sphere of acoustic energy that can be aimed at different regions of the brain to excite brain tissue.

For the new study, researchers placed it by the side of the man’s head and activated it 10 times for 30 seconds each, in a 10-minute period.

Monti said the device is safe because it emits only a small amount of energy — less than a conventional Doppler ultrasound.

“First-in-man” clinical trial

The patient was brought to the Ronald Reagan Medical Center (RRMC) at UCLA after suffering a road-traffic-related severe brain injury, with a field Glasgow Coma Scale (GCS) of 3 (“severe”). The patient had severe traumatic brain injury with prolonged loss of consciousness (more than 24 hours) post-injury.

Before the procedure began, the man showed only minimal signs of being conscious and of understanding speech. For example, he could perform small, limited movements when asked. By the day after the treatment, his responses had improved measurably.

Three days later, the patient had regained full consciousness and full language comprehension, and he could reliably communicate by nodding his head “yes” or shaking his head “no,” consistent with emergence from MCS (eMCS). He even made a fist-bump gesture to say goodbye to one of his doctors.

“The changes were remarkable,” Monti said.

The technique targets the thalamus because, in people whose mental function is deeply impaired after a coma, thalamus performance is typically diminished. Medications that are commonly prescribed to people who are coming out of a coma only indirectly target the thalamus.

Under the direction of Paul Vespa, a UCLA professor of neurology and neurosurgery at the David Geffen School of Medicine at UCLA, the researchers plan to test the procedure on several more people beginning this fall at the Ronald Reagan UCLA Medical Center. Those tests will be conducted in partnership with the UCLA Brain Injury Research Center and funded in part by the Dana Foundation and the Tiny Blue Dot Foundation.

Modern intensive care medicine has greatly increased the rates of survival after severe brain injury (BI). Nonetheless, a number of patients fail to fully recover from coma, and awaken to a disorder of consciousness (DOC) such as the vegetative state (VS) or the minimally conscious state (MCS) [1]. In these conditions, which can be transient or last indefinitely, patients can lose virtually all autonomy and have almost no treatment options [1,2]. In addition, these conditions place great emotional and financial strain on families, lead to increased burn-out rates among care-takers, impose financial stress on medical structures and public finances due to the costs of prolonged intensive care, and raise difficult legal and ethical questions [3].

Now there is a new drug being tested that actually reduces the plaque that builds up in the brain causing dementia…but it will take years before doctors have it available. Again, the public has to suffer because of restrictions and liabilities. Tell me the name of one person suffering with terminal dementia who would not offer themselves up as test subjects for this new drug…and I mean getting the drug, not a placebo so a ‘test’ can be authenticated. The whole process is a sham to keep grants, make money and prevent a cure reaching the market quickly. Sickening.

The use of sound waves to stimulate the brain is the same technology that is applied for hearing impairment with hearing aid devices. When the brain is stimulated by the electrical currents triggered by sound waves the brain functions are improved and/or sustained. I think it is really criminal that Medicare pays nothing towards hearing devices (only diagnostics) and doctors tend to ignore the need to keep someone’s hearing from deteriorating. Hearing, sight, etc. are important for brain health. I am glad to hear that some of the old wives tales about the benefits of electric shock and sound therapy are coming back….it’s music to my ears!

What hit me was the similarity of a medical device in Star Trek NG. They’d glue a little detail-busy rectangle to each temple, then give a “neuro stimulator” jolt to the patient. A brain version of a heart defibrillator. They used it in several episodes. This looks like the same idea but – of course – a much bigger gadget.

And the FDA? The same FDA that can’t get a rival epi-pen – a simple gul-durned auto injector, for goodness sake – approved will take years to approve this. Brain hackers wont wait. They, some of them, are very reckless. So if not waiting, reckless hackers – please document, so the efforts provide possibly usable data. Do it in the style of a documentary, and channel one of the TV “CSI’s” explaining science to the TV audience.

Interesting that the drug company who manufacturer’s Epi-pens also can come out with a generic version and cut the price in half….hmmmm…a day late and a dollar short. Something is drastically wrong with this picture!

When I read the title, I thought this was someone who was not conscious at all, but then in the article it stated, “Before the procedure began, the man showed only minimal signs of being conscious and of understanding speech.”. Love to hear how much this costs as it seems inexpensive and I liked the idea that before you pull the plug on someone in a vegetative state, you give this machine one good chance to wake them up or get the brain going again. This work so far seems like great progress, but they do need a few more than 1 case to confirm it was actually working vs. a case where he was waking up regardless and this just got lucky in their timing. I am all for the brain hackers to figure things out and if I am ever in a coma, please hack away… I think the most damage is done by not trying something and even if nothing works at least the families feel better about going the extra mile.

The patient was brought to the Ronald Reagan Medical Center (RRMC) at UCLA after suffering a road-traffic-related severe brain injury, with a field Glasgow Coma Scale (GCS) of 3 (“severe”). The patient had severe traumatic brain injury with prolonged loss of consciousness (more than 24 hours) post-injury.

I think FDA would require some emperically substantial statement about the quality of life of survivors following this technique. So it’s a bit of a chicken and egg dilemma and it can be argued ‘compassionate grounds’ isn’t enough because that is more about the well-being of the loved ones,etc, rather than the patient, per se? Unless we want to argue compassion the patient has for the distress of the loved ones left in vacuum in the event of the immediate negative outcome of no intervention.

But what kind of resolution can be achieved with this tech? Could it be applied with scanning like a raster upto individual neurons? What if it could be localised and distributed like Perelman’s p-cell tech?